From the Guidelines
Normal T-Wave Patterns
It is normal to have an upright T wave in lead V1 and a negative T wave in lead V6 is not typical, but T-wave negativity in lateral chest leads V5 and V6 can be seen in a small percentage of normal adults, particularly in older individuals or certain ethnic groups 1.
T-Wave Abnormalities
- T-wave abnormalities can occur with or without ST-segment abnormalities, and their interpretation should consider the clinical context and other ECG findings.
- In adults 20 years old and older, the normal T wave is inverted in aVR; upright or inverted in leads aVL, III, and V1; and upright in leads I and II and in chest leads V3 through V6 1.
- T-wave inversion in leads V5 and V6 is considered abnormal in most cases, but can be seen in 2% of white men and women 60 years of age and older, and in 2% of black men and women 40 years of age and older 1.
- The T-wave amplitude is most positive in lead V2 or V3, with reported normal standards varying by age, gender, and race 1.
Clinical Interpretation
In clinical practice, interpreting isolated T-wave abnormalities can be challenging, and it is essential to consider the entire ECG and clinical context to avoid misdiagnosis 1. The presence of T-wave inversion in leads V5 and V6 should prompt further evaluation, particularly in athletes or individuals with a family history of sudden cardiac death 1.
From the Research
T Wave Polarity in Leads V1 and V6
- The presence of an upright T wave in lead V1 and a negative T wave in lead V6 can be associated with significant coronary artery disease, particularly left circumflex (LCx) and left anterior descending (LAD) coronary artery lesions 2, 3.
- An upright T wave in lead V1 can be an indicator for coronary artery disease (CAD), and a bigger T-wave in V1 than in V6 can indicate CAD with LAD involvement 3.
- T wave abnormalities, including T wave amplitude in lead 1+V6 ≤0mV, can identify previous lateral infarction and LCx disease 4.
- The polarity of the T wave in lead V1 can be affected by right ventricular (RV) involvement in inferoposterior wall acute myocardial infarction (AMI), with proximal RCA disease showing a higher incidence of upright T wave 5.
Clinical Implications
- The evaluation of T wave polarity in lead V1 can have additional risk stratification potential in patients with suspected CAD 2.
- In patients with thoracic pain and a positive T-wave in V1, cardiac ischemia should be considered 3.
- T wave abnormalities can be used to identify patients with previous lateral wall myocardial infarction and circumflex artery disease 4.